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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200131
Report Date: 07/26/2024
Date Signed: 07/26/2024 04:26:17 PM

Document Has Been Signed on 07/26/2024 04:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PATHWAY, THEFACILITY NUMBER:
079200131
ADMINISTRATOR/
DIRECTOR:		CARSWELL, JOHNFACILITY TYPE:
772
ADDRESS:550 PATTERSON BLVD.TELEPHONE:
(925) 938-8050
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 16CENSUS: 12DATE:
07/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Nicole Paiste, Campus Administrator
TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 07/26/2024 at 11:30 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Holmes arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Business Office Manager, Sara Winschell and LVN Supervisor, Jame Wong and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of 16 (sixteen) all ambulatory. Campus Administrator, Nicole Paiste, arrived shortly.


LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 9 total bedrooms which 8 bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 71 degree Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 111 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygiene supplies were available for clients. There is a minimum of one week supply of non-perishable and 2-day perishables food supply.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 05/31/2024. Emergency Disaster Drill was last posted on 07/25/2024. First aid kit was observed to be complete. Fire drill was last conducted on 07/17/2024.

LIC809-C Continued....
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PATHWAY, THE
FACILITY NUMBER: 079200131
VISIT DATE: 07/26/2024
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LIC809-C (Page 2)

8 of 12 clients’ records were reviewed. Staff records were reviewed, and 3 of 4 have current first aid training and associated to the facility.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 08/02/2024:

LIC 500 Personnel Report
LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 400 Affidavit Regarding Client/Resident Cash Resources
LIC 402 Surety Bond
LIC 610D Emergency Disaster Plan - Reviewed
Liability Insurance - Reviewed

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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